Falls are not random events. 

They arise from reduced strength and power, impaired balance, slower reaction time, pain, medication effects, chronic disease and environmental hazards. 

Effective prevention demands more than exercise alone. 

It requires clinical reasoning, risk stratification, behavioural insight and sustained engagement over time. Preventive falls care must be evidence-based. 

Programs such as the Otago Exercise Program and the Sunbeam Program reduce falls when delivered with appropriate intensity and progression. However, without exercise adherence there is no prevention strategy. 

This is where the distinct contribution of physiotherapy becomes clear. 

What we do matters. How we do it matters more. 

Through structured assessment, physiotherapists identify modifiable risk factors and design targeted interventions aligned to comorbidities, pain, frailty status and personal goals. 

We titrate load safely in the presence of osteoarthritis, cardiovascular disease or neurological impairment. We adjust dosages based on response and manage flare-ups proactively to avoid dropout. 

Pain is not a reason to stop. It is a clinical signal to adapt. Physiotherapists also embed behaviour change techniques within intervention delivery. 

Drawing on frameworks such as the COM-B model for behaviour change and self-determination theory, we address capability, opportunity and motivation together. 

We use graded goal setting, self-monitoring and feedback and then follow up to reinforce long-term engagement. 

These are not add-ons. They are core components. 

Implementation research shows that effective falls programs rely on essential elements: progressive strength and balance challenge, individualisation, monitoring, progression and behavioural reinforcement. Removing these reduces effectiveness. 

Physiotherapists ensure that these components are preserved, even when programs are delivered via telehealth or in rural communities. Our national policy position reflects this evidence. 

In the APA’s 2026–27 federal pre-Budget submission, we called for expanded access to publicly funded physiotherapy in primary care to reduce avoidable hospital admissions and downstream costs from falls and fractures. 

This aligns with the Strengthening Medicare Taskforce recommendations, which emphasise multidisciplinary team-based care, prevention and early intervention. 

Falls prevention is central to primary care reform. 

We have endorsed the national Falls Prevention Alliance and continue to advocate for coordinated action. 

Falls contribute significantly to injury-related hospitalisations, loss of independence and residential aged care admissions. 

The economic burden is substantial, yet the solution is within reach. 

However, prevention cannot be delivered sustainably without appropriate funding. Current mechanisms do not adequately support the intensity and duration required for behavioural change. Short-term models undermine long-term outcomes. 

The recent Scope of Practice Review highlighted the importance of enabling health professionals to work to their full scope within multidisciplinary primary care teams. Physiotherapists working to full scope can screen, assess, intervene and coordinate. 

They can support colleagues, relieve pressure on emergency departments and improve population health. 

Falls prevention illustrates physiotherapy leadership in action. It demonstrates our capacity to integrate evidence, clinical skill and behaviour change science to deliver measurable outcomes at scale. 

Prevention is not optional. It is foundational. This is not limited to older Australians. 

Our advocacy for physiotherapy as foundational, preventive care extends to early childhood reform through initiatives such as Thriving Kids, where early identification and intervention can alter lifelong developmental trajectories. 

Across the life span, our message is consistent: invest early, act early and embed physiotherapy where it can have the greatest preventive impact. 

Rik Dawson APAM MACP 

APA Titled Gerontological Physiotherapist

APA National President